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Massachusetts Society of Radiologic Technologists Membership Application Pay online (processing fee applicable) Visit Us Online website | facebook | twitter MSRT Contact Information (to submit your application and payment by mail use the address below) E-mail: [email protected] | Phone: 781.422.3962 | Mailing Address: PO Box 565 East Taunton, MA 02718 Membership Eligibility Technologist: Certified by the ARRT or its equivalent or hold an unrestricted license under Massachusetts state statute and actively engaged in the field of Radiologic Technology Student: Shall be enrolled in an accredited Radiologic Technology program. Eligibility for this membership will terminate on conclusion or discontinuation of such enrollment. Student members shall have all the rights & obligations of members. + Select: Full Name E-mail Required Credentials Date of Birth Daytime Phone Number Mailing Address Notify me about 1/2 Day Seminars in these areas of MA Boston Cape Cod Central Merrimack Western Technologist $50 for 1 Year Check all modalities in which you are licensed or certified: Bone Density CT Diagnostic Interventional/CV Mammography MRI Nuclear Medicine PACS Radiation Therapy Ultrasound Are you registered with the ARRT? Yes No ARRT # Mass RT License # Are you an ASRT member? Yes No ASRT # Current Employer Highest Level of Education + Student or Graduate Bridge Members Date or Projected Date of Graduation Referred by MSRT member: Bridge: Shall have graduated from an accredited program in medical imaging or radiation therapy within 12 months of membership application, or are registered by the American Registry of Radiologic Technologists (ARRT) equivalent and are within 12 months of their initial certification. Quarter Century Club: Technolgist members who have maintained membership in the MSRT for twenty five (25) consecutive years New Member + Personal Information Membership Renewal QCC $50 for 1 Year Student $20 for 1 Year Bridge $70 for 2 Years School: Dates of Enrollment: Member Profile Update

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Massachusetts Society of Radiologic Technologists

Membership Application

Pay online (processing fee applicable)Visit Us Online website | facebook | twitter

MSRT Contact Information (to submit your application and payment by mail use the address below)

E-mail: [email protected] | Phone: 781.422.3962 | Mailing Address: PO Box 565 East Taunton, MA 02718

Membership Eligibility

Technologist: Certified by the ARRT or its equivalent or hold an unrestricted license under Massachusetts state statute and actively engaged in the field of Radiologic Technology Student: Shall be enrolled in an accredited Radiologic Technology program. Eligibility for this membership will terminate on conclusion or discontinuation of such enrollment. Student members shall have all the rights & obligations of members.

+ Select:

Full Name E-mailRequired

Credentials Date of Birth Daytime Phone Number

Mailing Address

Notify me about 1/2 Day Seminars in these areas of MA

Boston Cape Cod Central Merrimack Western

Technologist $50 for 1 Year

Check all modalities in which you are licensedor certified:

Bone Density CT Diagnostic Interventional/CV

Mammography MRI Nuclear Medicine PACS

Radiation Therapy Ultrasound

Are you registered with the ARRT?

Yes No ARRT # Mass RT License #

Are you an ASRT member? Yes No ASRT #

Current Employer Highest Level of Education

+ Student or Graduate Bridge Members

Date or Projected Date of Graduation

Referred by MSRT member:

Bridge: Shall have graduated from an accredited program in medical imaging or radiation therapy within 12 months of membership application,or are registered by the American Registry of Radiologic Technologists (ARRT) equivalent and are within 12 months of their initial certification.

Quarter Century Club: Technolgist members who have maintained membership in the MSRT for twenty five (25) consecutive years

New Member

+ Personal Information

Membership Renewal

QCC $50 for 1 Year Student $20 for 1 YearBridge $70 for 2 Years

School:

Dates of Enrollment:

Member Profile Update

http://www.msrt-ma.org

https://www.facebook.com/MSRT.MA#!/MSRT.MA

https://twitter.com/MSRT_MA

http://www.msrt-ma.org/continuing-education/ace-approval-process/